ACR Comment Letter on Section 911 of the MMA, 4/30/04
April 30, 2004
The Honorable Mark B. McClellan, M.D., Ph.D.
Administrator
Centers for Medicare and Medicaid Services (CMS)
Hubert Humphrey Building, Room 314-G
200 Independence Ave., SW
Washington, DC 20201
RE: Comments on Section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003
Dear Dr. McClellan:
The American College of Radiology (ACR), representing over 32,000 diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians and medical physicists, appreciates this opportunity to comment on the contracting reform established by Section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). The ACR values the Centers for Medicare and Medicaid Services (CMS) effort to obtain input from the provider community on the performance requirements and standards that will be expected of the new Medicare Administrative Contractors (MACs). We are aware of the comments submitted by the American Medical Association (AMA) and the ACR echoes those comments. Specifically, the ACR submits the following comments:
• The ACR greatly appreciates CMS’ efforts to ensure local physician input through the current state-specific Carrier Advisory Committee (CAC) process and does not support revision to this current process. Regardless of the number of MACs, there should be at least one CAC per state, and possibly more if more than one MAC provides services in a single state, as is occurring in the current process.
• CMS should continue to seek provider input in the development of Local Coverage Determinations (LCDs).
• The physician community must have open access to a Carrier Medical Director (CMD) at each state level.
• The ACR feels that CMS should continue to provide dedicated funding for provider education and that these funds should not be transferable to other contractor functions.
• CMS should continue to ensure timely and accurate payments during and after the transition between the old and new contractors.
• CMS should ensure that providers have a single point of contact for Medicare and avoid fragmentation of contractor functions.
The ACR feels strongly that the current Carrier Advisory Committee (CAC) process should be maintained during and after the transition to the new MACs. As we have indicated in previous comments to CMS, the College supports CAC requirements as outlined in section 2.7 of the Program Integrity Manual. The current CAC process, which requires a Medicare Carrier to “establish one CAC per state,” (2.7.2, Rev. 3, 11-22-00) is an established mechanism that effectively provides physicians with appropriate input into the local Medicare process. Due to the differences in geographic practice settings and patterns of care, it is imperative that a CAC exist for each state. Local CAC processes are vitally important to the functioning of physician practices.
An important piece of the current CAC process is physician input into the development of Local Coverage Determinations (LCDs). The ACR has nationwide networks of Radiology and Radiation Oncology CAC representatives who review draft LCDs in detail and provide comments to their local CMDs. This input by specialty physicians is an invaluable piece of the CAC process and should be maintained.
It is also the College’s position that the physician community must have open access to a Carrier Medical Director (CMD) at the state level. The ACR finds it imperative that the physician community have a physician contact – a peer who understands the clinical aspects of patient care, medical necessity, Local Coverage Determinations and local Medicare Carrier issues at the state level. In instances where a CMD serves more than one state, the ACR requests that CMS ensure an adequate level of funding for the CMD to travel in order to be available for face-to-face meetings with physicians in each state.
In addition, the ACR feels strongly that CMS should continue to provide funding for provider education and that these funds should not be transferable to other contractor functions. In order for providers to understand the intricacies of the Medicare system, it is vitally important that providers continue to be educated by Medicare contractors. The ACR also suggests that providers have a single point of contact for Medicare. In order to avoid confusion, CMS should stay away from fragmentation of contractor functions.
Finally, in order to ensure that beneficiary care is not disrupted, CMS should continue to ensure timely and accurate payments during and after the transition between the old and new contractors. CMS should anticipate possible software system problems and address these issues prior to the transition.
Thank you for the opportunity to provide input on the performance requirements and standards that will be expected of the new Medicare Administrative Contractors. The ACR is available to discuss the above comments in further detail or answer any questions you or your staff may have. Please contact me at 1-800-227-5463, ext. 4902 or via e-mail at hln@acr.org.
Sincerely,
Harvey Neiman, M.D.
Executive Director
American College of Radiology (ACR)
